Statement of Principles concerning herpes simplex (Reasonable Hypothesis) (No. 39 of 2018)

The instrument turns on a handful of statutory and medical concepts that define causation for administrative decision‑making.

Reasonable hypothesis: The SoP repeatedly uses the statutory threshold “reasonable hypothesis” and states that “At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting herpes simplex or death from herpes simplex with the circumstances of a person's relevant service” (s 9(1)). The instrument thereby converts medical and factual patterns into the discrete factors that, if established and linked to service, meet that threshold for claim purposes.

Herpes simplex and death from herpes simplex: Herpes simplex is defined as a clinical illness caused by HSV‑1 or HSV‑2 (s 7(2)). The SoP clarifies that although herpes simplex attracts ICD‑10‑AM code B00 or A60, the meaning for the SoP is the clinical definition in s 7(2) (s 7(3)-(4)). Death from herpes simplex is included where a terminal event or condition was contributed to by the person's herpes simplex (s 7(5)); “terminal event” is defined in the Schedule and includes causes such as pneumonia, respiratory failure, cardiac arrest and cessation of brain function (Schedule 1).

Factors that must exist: Section 9 is the operational core listing discrete factors that, if present in the specified temporal relationship to clinical onset or worsening, will suffice as the minimum to raise a reasonable hypothesis. The list is site‑specific in places (e.g. orofacial herpes, genital herpes, herpes simplex of the cornea, acute herpes simplex encephalitis or retinal necrosis, eczema herpeticum, herpes simplex of the lip) and includes general systemic or exposure states (e.g. being exposed to HSV‑1 or HSV‑2 within 30 days before clinical onset; being in an immunocompromised state as specified at the time of clinical onset) (s 9(1)-(30)).

Temporal windows and anatomical nexus: The SoP sets explicit temporal windows in which exposures, procedures or events must precede onset or worsening , for example, exposure within 30 days before clinical onset (s 9(1)); thermal or chemical burn within seven days before onset at or close to the site of the burn (s 9(3)); contact lens wear within 24 hours before onset of keratitis (s 9(11)(c)); cataract surgery within six weeks before keratitis onset (s 9(11)(a)); surgery to brain within 30 days before encephalitis (s 9(8)). “Close to the site” is defined in Schedule 1 as “at or within one centimetre” (Schedule 1).

Onset versus worsening; material contribution and aggravation: The SoP distinguishes factors that support a reasonable hypothesis for clinical onset and analogous factors for clinical worsening (s 9, subsections grouped for onset then worsening). Section 10(2) restricts factors in subsections 9(16) to 9(30) (the worsening list) to “material contribution to, or aggravation of, herpes simplex where the person's herpes simplex was suffered or contracted before or during (but did not arise out of) the person's relevant service.” Thus the instrument treats causation of a new infection and aggravation of a pre‑existing condition differently and imposes a relationship to service for aggravation claims.

Defined biomedical categories: Schedule 1 supplies operational definitions that adjudicators must use, such as “being exposed to HSV‑1 or HSV‑2” (including direct exposure to saliva or respiratory droplets, percutaneous exposure to vesicular fluid, sexual contact, or skin contact); “immunocompromised state as specified” (explicitly listing HIV infection, treatment with immunosuppressive drug, haematological or solid organ malignancy, asplenia/splenectomy, chronic renal failure, severe malnutrition, cardiopulmonary bypass, solid organ/stem cell/bone marrow transplantation) and “immunosuppressive drug” with examples (Schedule 1). These definitions fix the universe of qualifying clinical states and exposures.

Interaction with other SoPs: Section 11 requires that, where a factor in this SoP refers to an injury or disease for which another SoP exists, that other SoP’s factors apply according to its terms. This creates an interdependent network of SoPs rather than a purely self‑contained instrument.

Evidence standard: The SoP converts clinical and factual patterns into a statutory threshold for claim evaluation. It is a medical‑scientific instrument purporting to be grounded in evidence (s 8). It does not itself set administrative processes or evidentiary burdens beyond specifying which factors amount to the minimum to raise a reasonable hypothesis.

Primary affected parties

• Claimants: Veterans, members of Peacekeeping Forces, or members of the Forces who are making claims “to which section 120A of the VEA or section 338 of the MRCA applies” (s 5). The SoP operates as the RMA’s medical framework for determining whether a reasonable hypothesis exists that herpes simplex or death from herpes simplex is related to relevant service (s 9, s 10). It directly affects the subset of claimants who present with herpes simplex, its complications, or death where herpes simplex is contributory (s 7).

• Medical advisers and treating clinicians: The definitions and temporal windows in Schedule 1 and s 9 determine what medical evidence will be relevant. Clinicians providing reports must address items the SoP defines, for example whether the patient had “being exposed to HSV‑1 or HSV‑2 within the 30 days before clinical onset” (s 9(1)), or whether the patient was in an “immunocompromised state as specified” at onset (s 9(4)).

• Administrative decision makers and tribunal members: Adjudicators assessing claims under the VEA or MRCA will use this SoP to determine whether a reasonable hypothesis is raised. The SoP’s lists and definitions will guide the medical nexus analysis; decision makers must check that a listed factor exists in the specified temporal relation and that it is related to relevant service (s 10(1)).

Secondary affected parties

• Departmental agencies and payors: While the SoP itself does not list entitlements or payments, its use in claims determinations (s 5) influences the population of successful claims, and therefore has budgetary and operational consequences for the agencies that administer veterans’ benefits. The instrument also replaces a prior SoP (s 4), so agencies must update claim assessment protocols accordingly.

• Surgeons, ophthalmologists, transplant services and other treating specialists: Several factors specifically refer to surgery (for example nerve root ganglia surgery and brain surgery, s 9(5), s 9(8)), corneal transplant with infected donor cornea (s 9(11)(b)), cataract surgery (s 9(11)(a), s 9(25)(a)), and topical prostaglandin eye solutions (s 9(11)(d), Schedule 1). These specialists’ clinical records will be central evidence in claims.

• Employers and institutions: Certain factors (category 2 stressors, Schedule 1) include workplace disharmony, bullying or perceived lack of support. For claimants asserting a category 2 stressor, employers’ records or third‑party evidence may be relevant to support the existence and chronicity of the stressor.

Who decides and who pays

• The instrument is made by the Repatriation Medical Authority under s 196B(2) VEA (s 3). It supplies medical criteria for decision makers applying the VEA and MRCA provisions identified in s 5. The instrument does not itself specify payments or who pays; its effect is to define circumstances that can raise a reasonable hypothesis of service connection for claims under the statutory provisions referenced (s 5).

Practical impact on claimants

• The SoP reduces openness in the sense that a finite list of factors will be treated as sufficient to raise a reasonable hypothesis if related to service. Claimants lacking evidence that fits one of the listed factors may find it harder to rely on this SoP to establish service connection, and must either present other medical or factual material outside this SoP or rely on other SoPs if a cross‑referenced injury/disease applies (s 11). Conversely, claimants with evidence matching the specific factors and temporal windows have a clear, prescribed path to meet the minimum threshold for a reasonable hypothesis (s 9).

The instrument does not create freestanding statutory duties or civil rights in the sense of penalties or criminal offences. Instead, it creates definitional obligations and administrative expectations that affect how claims are assessed and how evidence should be presented.

Duties of decision makers and medical assessors

• Apply the SoP when relevant: The instrument applies to claims governed by VEA s 120A and MRCA s 338 (s 5). Decision makers must therefore consider the SoP when evaluating causation in those claims.

• Use the SoP’s definitions and temporal windows: The Schedule 1 definitions are part of the SoP (s 6, Schedule 1) and must be used when deciding whether a listed factor exists. For example, “close to the site” is defined as “at or within one centimetre,” which constrains any evidence that attempts to rely on a looser proximity standard (Schedule 1).

• Ensure relationship to relevant service: Section 10(1) requires that any factor in s 9 “must be related to the relevant service rendered by the person.” Decision makers must therefore not only find that a factor existed in the specified temporal relation but also that it was related to the person’s relevant service (s 10(1)). For aggravation claims involving subsections 9(16) to 9(30), section 10(2) adds the qualifier that those factors apply only to material contribution to or aggravation of herpes simplex where the condition was suffered or contracted before or during (but did not arise out of) the person's relevant service.

Rights or entitlements implicated

• Right to have a claim assessed against the RMA criteria: For claimants whose claims fall within the statutory scope (s 5), the SoP’s factors define a clear pathway to raising the threshold of a “reasonable hypothesis” of service connection (s 9). The SoP thereby shapes a claimant’s procedural right to a causation assessment based on the RMA’s medical view (s 8).

• Right to rely on cross‑referenced SoPs: Where a factor in this SoP refers to an injury or disease covered by another SoP, section 11 requires the other SoP’s factors to apply “in accordance with the terms of that Statement of Principles as in force from time to time.” Claimants therefore have the procedural right to have those other SoPs considered where the factors refer to them.

Obligations on claimants and clinicians in practice

• Evidential duty to document qualifying factors: Because the SoP’s factors are narrowly specified and time‑bounded (for example “within the 30 days before clinical onset” or “within the 24 hours before clinical onset”), claimants and treating clinicians must produce contemporaneous records that establish the timing and nature of exposures, operations, burns, systemic immunosuppression or other listed events (s 9, Schedule 1).

• Cross‑checking other SoPs where a factor references another condition: If a listed factor refers to another disease covered by a separate SoP, the claimant or clinician must assemble the relevant evidence expected by that other SoP, since section 11 makes the other SoP applicable.

Limits and non‑duties

• No obligation within the instrument to pay or award benefits: The SoP is a medical standard, not an award instrument. It does not itself create an entitlement to compensation; it specifies the medical factors that meet the minimum to raise a reasonable hypothesis for the purposes of the statutory claims listed in s 5.

• No criminal or civil penalties in the instrument: The SoP contains no enforcement fines, penalties or criminal offences; it is a declaratory and administrative medical instrument (see s 3, s 8, s 9).

The instrument contains no penal provisions, no enforcement fines and no criminal sanctions within its text. It is a Statement of Principles made under subsection 196B(2) of the VEA and functions as medical guidance for claim assessment (s 3, s 8). Consequently, the primary enforcement mechanism is administrative: the SoP is used by the statutory decision makers and the relevant claims processes to determine whether a reasonable hypothesis exists that herpes simplex or death from herpes simplex is related to relevant service (s 5, s 9).

Administrative enforcement and practical consequences

• Use in claim determination: The practical consequence of the SoP’s operation is that claims that meet the SoP’s minimum factors and the requirement that the factor be related to relevant service (s 10(1)) will be treated as having a reasonable hypothesis raised for the purposes of VEA s 120A or MRCA s 338 claims (s 5, s 9). How that translates into entitlement outcomes depends on those statutes and the administrative decision makers who apply them; the SoP itself supplies the medical nexus standard, not the payment rule.

• Revocation of prior SoP: Revocation of the 2010 SoP (s 4) is an administrative enforcement act: subsequent decisions and claim assessments should use the 2018 instrument rather than the prior instrument. Agencies managing claims must update their processes to reflect the new factors, temporal windows and definitions.

• Interaction with other SoPs: Section 11 creates an administrative enforcement interlock: where a factor in this SoP refers to another injury/disease covered by a separate SoP, the other SoP’s factors apply “in accordance with the terms of that Statement of Principles as in force from time to time.” In practice, decision makers must identify and apply the correct SoP(s) in a given claim.

No internal sanctions for non‑compliance stated

• The instrument does not specify consequences for decision makers who fail to apply it. Any remedies or consequences for incorrect application would arise under the administrative law, statutory review and appeals framework created by the VEA, MRCA and related administrative tribunals or courts , frameworks not set out in this instrument. The SoP itself contains no enforcement schedule, penalty regime or inspectorate.

Implementation risks that resemble enforcement issues

• Evidentiary friction: The SoP places particular burdens on claimants and treating clinicians to demonstrate factors within specific temporal windows and with defined clinical thresholds (for example “severe thermal burn” defined as requiring hospital admission, Schedule 1). Failure to produce adequate records may result in a decision that a reasonable hypothesis has not been raised, but that outcome flows from administrative application of the SoP, not from any penalty within the instrument.

• Inter‑SoP complexity: Section 11’s cross‑reference to other SoPs may create practical enforcement complexity where multiple SoPs intersect. Decision makers and claimants must correctly identify the applicable SoP(s) and ensure the evidence addresses the relevant instrument(s).

In short, enforcement of this instrument is administrative rather than penal. Its effect is realised through the statutory claim processes it governs (s 5), the RMA’s evidentiary constructions (s 8-9), and the administrative decisions that apply those constructions; the SoP does not autonomously impose fines, sanctions or criminal liability.

Direct statutory anchoring

• Made under VEA s 196B(2): The instrument is an SoP determined under subsection 196B(2) of the Veterans' Entitlements Act 1986 (s 3). It therefore derives its legal role from the VEA’s statutory framework for medical determinations. The instrument explicitly applies to claims to which VEA s 120A or MRCA s 338 applies (s 5). Those statutory provisions (which are not reproduced in this instrument) will define the broader legal consequences of having a reasonable hypothesis raised; the SoP supplies the medical criteria used under that statutory mechanism.

Inter‑instrument references

• Cross‑SoP application (s 11): The SoP anticipates linkages to other Statements of Principles. Section 11 provides that if a factor in this SoP refers to an injury or disease covered by another SoP, then the factors in that other SoP “apply in accordance with the terms of that Statement of Principles as in force from time to time.” Practically, application of this SoP may require decision makers to switch to or add another SoP’s criteria, which can alter the causal analysis and the temporal windows or clinical thresholds.

ICD‑10‑AM coding and clinical meaning

• ICD‑10‑AM codes noted but not determinative (s 7(3)-(4)): The instrument recognises that herpes simplex attracts ICD‑10‑AM codes B00 or A60 but it expressly states that, for the purposes of the SoP, the meaning of herpes simplex is the clinical definition set out in s 7(2). The SoP therefore uses clinical definitions rather than relying solely on diagnostic coding. It also specifies the edition of ICD‑10‑AM referred to (Tenth Edition, effective 1 July 2017) (s 7(4)).

Relationship to entitlement statutes

• Application to VEA and MRCA claim processes (s 5): The SoP is intended to be used within the claim processes governed by specific provisions of the VEA and MRCA. The instrument itself does not restate the appellate or review mechanisms in those statutes, or the substantive entitlements awarded where service connection is found. Those features are governed by the VEA and MRCA; this instrument is part of the evidentiary architecture feeding into those statutory determinations.

Administrative law and evidence

• Evidential standard and administrative review: The SoP sets out the circumstances that satisfy the minimum to “raise a reasonable hypothesis” of service connection. Administrative decision makers, and reviewing courts or tribunals if an appeal is brought, will evaluate whether the SoP was properly applied. The SoP does not alter general administrative law obligations such as procedural fairness or rules of evidence; it provides the medical matrix that decision makers must apply within that legal framework.

Overlap with clinical regulation and professional responsibilities

• Clinical records and professional practice: The SoP’s defined factors make certain types of clinical documentation more salient for claims. Medical practitioners and hospitals providing treatment must be aware that information such as dates of surgery, hospital admission for burns, medication lists (immunosuppressive drugs) and ophthalmic treatments (topical prostaglandin eye solutions) will be relevant evidence for administrative claim purposes. The SoP does not change clinicians’ professional regulatory duties, but it does define what clinicians should record if a patient’s care might be the subject of a veterans’ claim.

No express conflict or displacement clauses

• The instrument does not purport to override other statutes, regulations or common law; rather it operates as a medical statement under the statutory regime it invokes (s 3, s 5). Where it cross‑references other SoPs (s 11), those SoPs apply in their terms; the SoP therefore forms part of an interlocking administrative medical framework rather than acting as a standalone legal code.

The instrument contains its own dates and immediate amendment effect, and does not list any prior amendments beyond the revocation noted.

• Date of determination and commencement: The instrument is dated 27 April 2018 (front page) and “commences on 28 May 2018” (s 2). Those dates in the instrument establish when its contents became operative.

• Revocation of previous SoP: Section 4 revokes “The Statement of Principles concerning herpes simplex No. 3 of 2010 made under subsection 196B(2) of the VEA.” That is the only express revocation or amendment action recorded in the instrument.

• No internal amendment provisions: The instrument does not include provisions for future amendment, saving or transitional arrangements in its text. It instead operates as the RMA’s SoP in force from commencement onward, and section 11 anticipates that other SoPs may be “as in force from time to time,” implying that any changes to cross‑referenced SoPs will affect how cross‑references operate.

• No legislative history or explanatory memorandum included: The document supplied contains the SoP itself and the formal recitals (date, signatures, seal). It does not include an Explanatory Memorandum, regulatory impact statement or legislative history. The only formal statement about the basis for the instrument is in s 8, where the RMA states it is “of the view that there is sound medical‑scientific evidence that indicates that herpes simplex and death from herpes simplex can be related to relevant service.”

• Practical implication of revocation: Repealing the 2010 SoP requires claims assessed after the commencement date to be evaluated against the 2018 criteria (s 4). Administrators must ensure that legacy claims are transitioned appropriately, but the instrument itself provides no transitional wording; any transitional arrangements would have to be derived from the VEA/MRCA claims processes or administrative practice outside the instrument.

• No recorded subsequent amendments within the instrument: The text provided contains no later amending instruments or annotation. If there have been later amendments, they are not contained in this document.

The instrument itself contains no case citations and records no litigation. It does not refer to any judicial or tribunal decisions. Accordingly:

• The SoP supplies the RMA’s view that there is sound medical‑scientific evidence for a relationship between herpes simplex and relevant service (s 8), but it does not cite or reproduce the underlying studies or judicial considerations.

• The document does not identify any legal challenges to this SoP, nor does it list cases that have tested its operation. If litigation or tribunal decisions have since considered this SoP, those decisions are not part of the text provided and therefore cannot be cited or summarised from this instrument.

• Any court or tribunal treatment of this SoP would be found in external case law databases and administrative records, not in the instrument itself. Users needing litigation history should search the appellate and tribunal databases for decisions that mention “Statement of Principles concerning herpes simplex (No. 39 of 2018)” or references to the RMA’s 2018 herpes simplex SoP.

Because no litigation material is in the instrument, this section records only that none is named or referenced in the document provided.

The instrument contains multiple tightly framed definitions and temporal requirements that create pitfalls for claimants, clinicians and adjudicators. Key points where failures of proof or mis‑application commonly occur are set out below with direct references to the relevant provisions.

Narrow temporal windows and precise timing (s 9, Schedule 1)

• Many factors require proof that a qualifying event occurred within a short, specified window before clinical onset or worsening: 30 days for general exposure and certain surgeries (s 9(1), s 9(5), s 9(8)); seven days for thermal/chemical burns or upper respiratory tract infections (s 9(3), s 9(9)(b)); 24 hours for contact lens wear before keratitis (s 9(11)(c)); 48 hours for chapped lips or playing a wind/brass instrument before lip herpes (s 9(15)); 72 hours for fever ≥39°C preceding orofacial herpes (s 9(9)(c)). Missing or vague dates in clinical records will often prevent a finding that the factor exists within the required window.

Strict clinical definitions (Schedule 1)

• “Severe thermal burn” is defined as a burn of sufficient severity to warrant hospital admission as an inpatient (Schedule 1). A claimant with a self‑treated burn or outpatient treatment will likely fail to meet this definition even if the burn was clinically significant. Evidence must show inpatient admission.

• “Close to the site” is fixed as “at or within one centimetre” (Schedule 1). In many practical scenarios, wound proximity is described in broader terms; precise measurement or photographic evidence may be necessary.

• “Immunocompromised state as specified” lists a closed set of conditions such as HIV infection, treatment with an immunosuppressive drug (examples given), malignancy, asplenia, chronic renal failure, cardiopulmonary bypass, severe malnutrition, or transplantation (Schedule 1). If a claimant asserts immunosuppression from another cause not listed, decision makers will need to assess whether that cause amounts to “substantially lowered immune function,” but the instrument’s list is the primary guide.

Clinical‑procedure matching and dermatome correspondence (s 9(5), Schedule 1)

• For nerve root ganglia surgery, the SoP requires that “the cutaneous distribution of herpes simplex corresponds with the nerve roots which were manipulated during surgery” (s 9(5)). This creates a need for both operative notes specifying which nerve roots were manipulated and dermatome mapping or clinical description linking lesions to those roots.

Site‑specific triggers and adjuvant treatments (s 9(11), Schedule 1)

• Ophthalmic factors include cataract surgery within six weeks (s 9(11)(a)), corneal transplant with infected donor cornea within 30 days (s 9(11)(b)), contact lens wear within 24 hours (s 9(11)(c)), and topical prostaglandin eye solution used for at least one week before onset (s 9(11)(d)). Records must identify the specific drug (Schedule 1 lists latanoprost, bimatoprost, tafluprost or tavoprost) and duration, and donor cornea infection status can be difficult to obtain.

Onset versus worsening and the limitation for aggravation claims (s 10(2))

• The factors listed at subsections 9(16)-9(30) apply only to material contribution to, or aggravation of, herpes simplex where the person’s herpes simplex was suffered or contracted “before or during (but did not arise out of) the person's relevant service” (s 10(2)). This limits the application of the worsening factors to aggravated pre‑existing cases; if the condition arose out of service (i.e. originated as a result of service), those subsections do not apply for material contribution/aggravation analysis. Correctly classifying whether the condition arose out of service or was pre‑existing is therefore critical.

Cross‑SoP dependencies (s 11)

• A factor in this SoP may refer to a different injury or disease for which another SoP governs. Section 11 makes the other SoP’s factors applicable according to its terms. Practically, failure to identify and apply the cross‑referenced SoP may lead to incorrect causal analysis.

Clinical confirmation versus “clinical illness” language (s 7(2))

• The SoP defines herpes simplex as a “clinical illness” caused by HSV‑1/HSV‑2 (s 7(2)) but does not expressly require laboratory confirmation in this instrument. Decision makers conversant with the VEA/MRCA framework must decide whether laboratory evidence is necessary in each case. Absence of lab confirmation may be a point of contention, particularly where documentation of onset timing is poor.

Category 2 stressor breadth (Schedule 1)

• “Category 2 stressor” covers a wide range of chronic social and economic stressors, including workplace disharmony, prolonged unemployment, being a full‑time caregiver, or serious legal issues (Schedule 1). Evidence of chronicity and the claimant’s subjective distress may be required. The breadth of this category can both help and hinder claims depending on the documentation available.

Specific and potentially unexpected triggers (s 9(15))

• The inclusion of “playing a woodwind or brass musical instrument in the 48 hours before the clinical onset” as a factor for lip herpes (s 9(15)(b)) is a granular trigger that may be overlooked by clinicians and claimants alike. Ensure relevant hobby or occupational activities are recorded.

Death and terminal events (s 7(5), Schedule 1)

• The SoP includes death where herpes simplex “contributed to” a terminal event (s 7(5)), and the Schedule defines terminal events broadly (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Establishing contribution to death requires clinical linkage and may be contested without detailed records.

Operational gotchas for evidence gathering

• Lack of inpatient records for burns, incomplete medication lists (immunosuppressives), absence of operative notes specifying manipulated nerve roots or brain surgery details, missing ophthalmic donor cornea infection records, and absence of contemporaneous documentation for stressors or exposures are predictable failure points.

Compliance here means what clinicians, claimants, advisers and decision makers should do to ensure the SoP’s factors can be properly applied and proved in claims governed by VEA s 120A and MRCA s 338 (s 5). The SoP is a medical instrument; compliance is primarily evidential and procedural.

For claimants and advisers (lawyers, advocates, case managers)

• Verify statutory scope early: Confirm the claim falls within the statutory provisions cited in s 5 (claims to which VEA s 120A or MRCA s 338 applies). The SoP governs causation assessment only for claims within that scope.

• Map the clinical presentation to the specific factors in s 9: Identify whether the claim is for initial clinical onset or for clinical worsening. For onset, focus on s 9(1)-(15) and the relevant site‑specific items (orofacial, genital, corneal, encephalitis, retinal necrosis, lip). For worsening, use s 9(16)-(30), keeping in mind s 10(2)’s material contribution/aggravation limitation.

• Collect contemporaneous medical records matching the SoP’s definitions and temporal windows: The instrument requires evidence that a listed factor existed within strict windows (e.g. 30 days, seven days, 24 hours). Assemble hospital admission records for burns (to meet “severe thermal burn,” Schedule 1), operative notes (including which nerve roots were manipulated, if relevant, s 9(5)), ophthalmic procedure notes and donor cornea infection details (s 9(11)(b)), medication histories showing immunosuppressive drugs and durations (Schedule 1), pregnancy records (s 9(7)), and documentation of exposure events (e.g. sexual contact, percutaneous exposure) within the specified periods (s 9(1)).

• Address immunocompromised states explicitly: The Schedule defines “immunocompromised state as specified” with a closed list of examples (Schedule 1). Provide serology or diagnosis for HIV, oncology records for malignancy, transplant documentation, dialysis records for chronic renal failure, or prescriptions for immunosuppressive drugs. If there is immunosuppression from other causes, prepare expert evidence linking that state to “substantially lowered immune function.”

• Prepare dermatome and anatomical linkage evidence where required: For nerve root surgery claims, obtain operative notes identifying nerve roots manipulated and clinical descriptions or maps of lesion distribution to show correspondence (s 9(5)). Similarly, for burns adjacent to lesions, provide photographic or measurement evidence to demonstrate proximity within one centimetre if relying on “close to the site” (Schedule 1).

• Document heterogeneous stressors: Where a category 2 stressor is relied on (Schedule 1), gather employment records, social services records, caregiving schedules, financial hardship documentation, or police/court records that evidence the chronicity and distress identified in the Schedule.

• Address cross‑referenced SoPs: If any factor refers to an injury or disease covered by another SoP (s 11), identify that SoP and assemble evidence that meets its terms “as in force from time to time.” Cross‑SoP knowledge is essential.

For treating clinicians and hospitals

• Record precise dates and specifics: Since the SoP relies on narrow temporal windows, ensure clinical notes record exact dates and times of symptom onset, exposures, surgeries, burns, medication start/stop dates, and contact lens use. Explicitly state whether a burn warranted inpatient admission (severe thermal burn, Schedule 1).

• Use SoP language when appropriate: If a patient is likely to make a claim, clinicians should be aware of the SoP definitions and, where clinically accurate, note items in the patient record using the terms in the Schedule (for example “chapped lips” as defined, contact lens use within 24 hours, topical prostaglandin eye solution by drug name and duration).

• Provide targeted expert reports: If a claim requires expert medical evidence to link a procedure or exposure to herpes simplex (for example matching dermatome distribution or assessing immunosuppression impact), supply reports that address the SoP’s specific factors and temporal requirements.

For decision makers and administrators

• Apply the SoP’s definitions and temporal windows strictly: When assessing whether a reasonable hypothesis has been raised (s 9), apply the Schedule definitions literally , for example hospital admission for severe burns, “at or within one centimetre” for proximity.

• Check for cross‑SoP application: Use s 11 to identify when another SoP applies and ensure the factors in that SoP are also considered.

• Update operational procedures: Replace references to the revoked 2010 SoP (s 4) with this 2018 SoP in internal guidance, forms, and medical assessment templates.

Evidence checklist template (practical)

• For suspected herpes simplex onset claims: documentation of date/time of clinical onset; evidence of exposure to HSV within 30 days where alleged (Schedule 1 definition); inpatient records for burns if alleged; surgical notes (nerve root, facial, brain) including dates and details; pregnancy records if relevant; immunosuppression documentation; ophthalmic surgical/medication records; records of contact lens use.

• For worsening/aggravation claims: evidence establishing the condition pre‑existed before or during service; then provide the same types of evidence as above but within the windows applicable to worsening (s 9(16)-(30)), and ensure material contribution/aggravation nexus to service is documented per s 10(2).

Practical tips

• Anticipate gaps and address them with contemporaneous affidavits or expert opinion where primary clinical documentation is absent. Be aware that decision makers may give less weight to uncorroborated retrospective statements, particularly where narrow timing is essential.

• Where donor tissue infection status is relevant (corneal transplant), engage with ophthalmic services to obtain donor cornea screening or records; these may be held by surgical centres or tissue banks.

• For claims involving death, assemble the terminal event documentation (cause of death certificate, hospital records) and opinions linking herpes simplex as a contributing condition (s 7(5), Schedule 1 definition of terminal event).

• When in doubt about whether a condition “arose out of” service or was “suffered or contracted before or during” service for the purposes of s 10(2), document both the temporal sequence and provide expert opinion addressing that statutory distinction.

By following the SoP’s definitions and temporal requirements, claimants, clinicians and administrators will best position themselves to meet the instrument’s minimum threshold for raising a reasonable hypothesis that herpes simplex or death from herpes simplex is related to relevant service.